Development of a Quality Improvement Dental Chart Review Training Program - PubMed (original) (raw)
Development of a Quality Improvement Dental Chart Review Training Program
Elsbeth Kalenderian et al. J Patient Saf. 2022.
Abstract
Introduction: Chart review is central to understanding adverse events (AEs) in medicine. In this article, we describe the process and results of educating chart reviewers assigned to evaluate dental AEs.
Methods: We developed a Web-based training program, "Dental Patient Safety Training," which uses both independent and consensus-based curricula, for identifying AEs recorded in electronic health records in the dental setting. Training included (1) didactic education, (2) skills training using videos and guided walkthroughs, (3) quizzes with feedback, and (4) hands-on learning exercises. In addition, novice reviewers were coached weekly during consensus review discussions. TeamExpert was composed of 2 experienced reviewers, and TeamNovice included 2 chart reviewers in training. McNemar test, interrater reliability, sensitivity, specificity, positive predictive value, and negative predictive value were calculated to compare accuracy rates on the identification of charts containing AEs at the start of training and 7 months after consensus building discussions between the 2 teams.
Results: TeamNovice completed independent and consensus development training. Initial chart reviews were conducted on a shared set of charts (n = 51) followed by additional training including consensus building discussions. There was a marked improvement in overall percent agreement, prevalence and bias-adjusted κ correlation, and diagnostic measures (sensitivity, specificity, positive predictive value, and negative predictive value) of reviewed charts between both teams from the phase I training program to phase II consensus building.
Conclusions: This study detailed the process of training new chart reviewers and evaluating their performance. Our results suggest that standardized training and continuous coaching improves calibration between experts and trained chart reviewers.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Conflict of interest statement
Research reported in this publication was supported by the National Institute of Dental and Craniofacial Research of the National Institutes of Health under Award Number R01DE022628. The authors disclose no conflict of interest.
Figures
Figure 1:
Dental Adverse Event Severity Scale (modified from Institute for Healthcare Improvement) E1: Temporary (reversible or transient) minimal/mild harm to the patient (healed or resolved without permanent defect or disability) E2: Temporary moderate to severe harm to the patient F: Patient transferred to emergency room and/or hospital G1: Permanent minimal/mild patient harm (healed with permanent defect or disability) G2: Permanent moderate to severe patient harm H: Intervention required to sustain life I: Patient death
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